NBME
Cardiology
Pharyngeal pouches are ectodermally derived and exam exam makers
want you to know that that is going to be ectodermal and neural crest
derived. The first pouch gives rise to the eustachian tube and the middle
ear cavity. The third pouch is the two pouches that are abnormal in
dijord syndrome. This is an integrative session, so remember that
patients who have digeorge syndrome are going to have recurrent
infections in your exam questions related to viral and fungal diseases.
Statins are hmg coa reductase inhibitors and they are going to
upregulate ldl receptors onto pathocytes. That in turn decreases ldl
levels with statins. Azidomide is going to be inhibiting cholesterol
absorption in the gut. Cholestyramine specifically inhibits bile acid
reuptake in the terminal ileum.
Nicotinamide (niacin) increases good cholesterol nicely, but niacin has a
bad side effect and that is it can cause you to become hyperuricemic
and exacerbate gout. Fibrates activate the protein ppar alpha, which is a
gene transcription factor, and that 's going to actually increase fat
metabolism and fibrates will reduce triacylglyceride levels but, like
statins, they can cause some myopathy. An experimental trial is studying
the modulation of receptormediated endocytosis via clathrincoated pits
as it relates to lipid metabolism inhibition of receptor degradation via
inactivation of the endo lysosomal construct. Statins are wonderful,
excellent, great, and I encourage you all to participate! However, statins
and vibrates are absolutely correct - this is a little bit of active recall
space repetition. The next topic that we're going to be going through is
shock. This is a tough tough concept but it comes up a lot and I want
you to recognize that usmle questions love to go for arrows in various
shock questions. What's important is to take experimental data that they
give you and relate it to the content you study.
,Arrow questions for the USMLE prediction are key. What does this
elevated alveolar interstitial hydrostatic pressure have to do with high
yield concepts? We are going to be going through this webinar in an
active recall and integrative way all right so when we're talking about
shock for the USMLE you want to understand what is the primary
etiology that triggers the downstream response in cardiogenic shock for
example it is pump failure i.e. low cardiac output. If you have a low
mixed venous oxygen saturation you will have an increased metabolic
demand. Increased metabolic demand is going to trigger your tissues to
extract more oxygen. The mixed venous oxygen saturation is usually
measured by a catheter at the internal jugular subclavian vein. It is a
surrogate for oxygen extraction such that especially in times of shock if
you have high o2 extraction in the peripheral circulation i.e. you have
increased metabolic demand you are going to have a low mixed venous
oxygen saturation.
Septic shock is a condition that results from intense cytokine
production. This can lead to a drop in systemic vascular resistance,
which in turn causes high output cardiac failure and an increased transit
time through the capillary system. In addition, anaphylactic shock can be
a type 1 hypersensitivity response, in which oxygen cannot effectively
dissociate from hemoglobin. A prominent jugular vein is appreciated;
bedside echo shows a collapsed atria in the diastole. Your cardiac
output will go up, and when you are thinking about not utilizing oxygen,
this is a typo. Please make a change for yourself. Dissociative shock
cannot utilize oxygen, and if the tissues can't extract the oxygen well
then what's going to happen is you'll have high mixed venous oxygen
saturation (SVR), which comes back to your service junction. Cardiology
section of first aid and respiratory should be mixed together and we'll
talk about oxygen delivery in first aid. How do you get oxygen to the rest
of your body? Oxygen content as well as cardiac output is going to be a
function of a few things, such as oxygen content and cardiac output.
,There are many questions on thermoregulation, including how a person
responds to shivering, cold, and very high temperatures. When it comes
to a patient's bedside, it counts all of these concepts. The S3 and S4
heart sounds during what phase of the cardiac cycle are you going to
hear them? The presence of an S3 gallop is one of the best markers of
mitral regurgitation severity. Heat exhaustion or even heat stroke
especially will have absent sweating in your test questions. S3
represents the atria filling into a very dilated left ventricle in the diastole.
S4 represents the late diastolic sound, and it's actually going to be heard
at the part of the cardiac cycle related to atrial contraction or atrial
systole. Usually that's because there is hypertrophy of the left ventricular
heart.
MVP (males), HOKUM (females), good pastures, hemoptysis, hematuria,
type 2 hypersensitivity, antigbm antibodies, microscopic polyangiitis,
granulomatosis, corticosteroids, giant cell temporal arteritis, unstable
angina, atherosclerosis, transmural infarction.
, Endocrinology
We will cover the following important USMLE concepts related to
endocrinology:Hyper and hypothyroidismParathyroid hormone and
different questions related to calcium regulationMEN syndromes and the
multiple endocrine neoplasia syndromesIntegrating some islet cell
tumors that you may see on your examA little bit of a compare and
contrast related to type 1 and type 2 diabetes and the extremes of these
pathologies being DKA.
What we will cover is the various mechanisms of each hormone. It is
important to remember that for the USMLE, questions may not only ask
for hormone names but also whether they upregulate or downregulate a
certain pathway.For the anterior pituitary hormones such as FSH, LH,
ACTH, and TSH, they work via the cyclic AMP or G protein-coupled
receptor (GPCR) pathway. Parathyroid hormone (PTH), on the other
hand, can be remembered as the 'phosphate trashing hormone', which
increases calcium and decreases foss. It works via the Gq pathway and
the GS pathway. While learning the process for these pathways may be
helpful, in a test-taking setting, recognizing and making connections
between the various components of the pathway may be more useful.
For example, hearing DAG, IP3, PIP2, and protein kinase often signifies
the Gq pathway on the USMLE.The next portion of this will discuss hyper
and hypothyroidism. When encountering thyroid disorder questions, it is
helpful to categorize them as either hyper or hypothyroidism by noticing
if the patient exhibits symptoms such as tachycardia, isolated systolic
hypertension, tremors, arrhythmias, and exopthalmos (bulging eyes).
Cardiology
Pharyngeal pouches are ectodermally derived and exam exam makers
want you to know that that is going to be ectodermal and neural crest
derived. The first pouch gives rise to the eustachian tube and the middle
ear cavity. The third pouch is the two pouches that are abnormal in
dijord syndrome. This is an integrative session, so remember that
patients who have digeorge syndrome are going to have recurrent
infections in your exam questions related to viral and fungal diseases.
Statins are hmg coa reductase inhibitors and they are going to
upregulate ldl receptors onto pathocytes. That in turn decreases ldl
levels with statins. Azidomide is going to be inhibiting cholesterol
absorption in the gut. Cholestyramine specifically inhibits bile acid
reuptake in the terminal ileum.
Nicotinamide (niacin) increases good cholesterol nicely, but niacin has a
bad side effect and that is it can cause you to become hyperuricemic
and exacerbate gout. Fibrates activate the protein ppar alpha, which is a
gene transcription factor, and that 's going to actually increase fat
metabolism and fibrates will reduce triacylglyceride levels but, like
statins, they can cause some myopathy. An experimental trial is studying
the modulation of receptormediated endocytosis via clathrincoated pits
as it relates to lipid metabolism inhibition of receptor degradation via
inactivation of the endo lysosomal construct. Statins are wonderful,
excellent, great, and I encourage you all to participate! However, statins
and vibrates are absolutely correct - this is a little bit of active recall
space repetition. The next topic that we're going to be going through is
shock. This is a tough tough concept but it comes up a lot and I want
you to recognize that usmle questions love to go for arrows in various
shock questions. What's important is to take experimental data that they
give you and relate it to the content you study.
,Arrow questions for the USMLE prediction are key. What does this
elevated alveolar interstitial hydrostatic pressure have to do with high
yield concepts? We are going to be going through this webinar in an
active recall and integrative way all right so when we're talking about
shock for the USMLE you want to understand what is the primary
etiology that triggers the downstream response in cardiogenic shock for
example it is pump failure i.e. low cardiac output. If you have a low
mixed venous oxygen saturation you will have an increased metabolic
demand. Increased metabolic demand is going to trigger your tissues to
extract more oxygen. The mixed venous oxygen saturation is usually
measured by a catheter at the internal jugular subclavian vein. It is a
surrogate for oxygen extraction such that especially in times of shock if
you have high o2 extraction in the peripheral circulation i.e. you have
increased metabolic demand you are going to have a low mixed venous
oxygen saturation.
Septic shock is a condition that results from intense cytokine
production. This can lead to a drop in systemic vascular resistance,
which in turn causes high output cardiac failure and an increased transit
time through the capillary system. In addition, anaphylactic shock can be
a type 1 hypersensitivity response, in which oxygen cannot effectively
dissociate from hemoglobin. A prominent jugular vein is appreciated;
bedside echo shows a collapsed atria in the diastole. Your cardiac
output will go up, and when you are thinking about not utilizing oxygen,
this is a typo. Please make a change for yourself. Dissociative shock
cannot utilize oxygen, and if the tissues can't extract the oxygen well
then what's going to happen is you'll have high mixed venous oxygen
saturation (SVR), which comes back to your service junction. Cardiology
section of first aid and respiratory should be mixed together and we'll
talk about oxygen delivery in first aid. How do you get oxygen to the rest
of your body? Oxygen content as well as cardiac output is going to be a
function of a few things, such as oxygen content and cardiac output.
,There are many questions on thermoregulation, including how a person
responds to shivering, cold, and very high temperatures. When it comes
to a patient's bedside, it counts all of these concepts. The S3 and S4
heart sounds during what phase of the cardiac cycle are you going to
hear them? The presence of an S3 gallop is one of the best markers of
mitral regurgitation severity. Heat exhaustion or even heat stroke
especially will have absent sweating in your test questions. S3
represents the atria filling into a very dilated left ventricle in the diastole.
S4 represents the late diastolic sound, and it's actually going to be heard
at the part of the cardiac cycle related to atrial contraction or atrial
systole. Usually that's because there is hypertrophy of the left ventricular
heart.
MVP (males), HOKUM (females), good pastures, hemoptysis, hematuria,
type 2 hypersensitivity, antigbm antibodies, microscopic polyangiitis,
granulomatosis, corticosteroids, giant cell temporal arteritis, unstable
angina, atherosclerosis, transmural infarction.
, Endocrinology
We will cover the following important USMLE concepts related to
endocrinology:Hyper and hypothyroidismParathyroid hormone and
different questions related to calcium regulationMEN syndromes and the
multiple endocrine neoplasia syndromesIntegrating some islet cell
tumors that you may see on your examA little bit of a compare and
contrast related to type 1 and type 2 diabetes and the extremes of these
pathologies being DKA.
What we will cover is the various mechanisms of each hormone. It is
important to remember that for the USMLE, questions may not only ask
for hormone names but also whether they upregulate or downregulate a
certain pathway.For the anterior pituitary hormones such as FSH, LH,
ACTH, and TSH, they work via the cyclic AMP or G protein-coupled
receptor (GPCR) pathway. Parathyroid hormone (PTH), on the other
hand, can be remembered as the 'phosphate trashing hormone', which
increases calcium and decreases foss. It works via the Gq pathway and
the GS pathway. While learning the process for these pathways may be
helpful, in a test-taking setting, recognizing and making connections
between the various components of the pathway may be more useful.
For example, hearing DAG, IP3, PIP2, and protein kinase often signifies
the Gq pathway on the USMLE.The next portion of this will discuss hyper
and hypothyroidism. When encountering thyroid disorder questions, it is
helpful to categorize them as either hyper or hypothyroidism by noticing
if the patient exhibits symptoms such as tachycardia, isolated systolic
hypertension, tremors, arrhythmias, and exopthalmos (bulging eyes).
